There is considerable controversy in treatment of pediatric medial epicondyle fractures with regards to the amount of fracture displacement. The purposes of the study are three-fold; to identify the orientation of the medial elbow physis, to compare the accuracy of determining fracture displacement between axial x-rays and standard AP x-rays, and to determine the relationship between the amount of fracture displacement and loss of terminal elbow extension.

Materials & Methods:

12 Pediatric elbow CTÕs and 19 Pediatric elbow MRIÕs were analyzed for the orientation of the medial elbow physis. After determining the correct orientation of the medial physis, 15 adult cadaveric medial epicondyle fracture models were created in the correct orientation at displacements of 2mm, 5mm, 10 mm, and maximum displacement with elbow at 90 degrees of flexion. A linear mixed model regression analysis was used to compare displacement based on the axial versus the AP radiographic methods. Lateral x-rays were taken at the maximum elbow extension in each fracture model and a linear mixed model regression analysis was used to assess fracture displacement in relation to terminal elbow extension.

Understanding the medial epicondyle physeal location and orientation will help clinicians to more anatomically reduce these fractures. Having an x-ray technique that better estimates the actual displacement and knowing how fracture displacement affects elbow terminal extension will provide for better delineation of fractures that could be non-operatively treated verses those that warrant operative fixation.